Provider Demographics
NPI:1760649578
Name:KWASNIK, ANNA IZABELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:IZABELA
Last Name:KWASNIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1940
Mailing Address - Country:US
Mailing Address - Phone:718-679-3570
Mailing Address - Fax:
Practice Address - Street 1:47 ELM ST
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1940
Practice Address - Country:US
Practice Address - Phone:718-679-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0548361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice